Surgical Respiratory Diseases Flashcards
What are the features of Brachycephalic Obstructive Airway Syndrome (BOAS)?
Stenotic nares Overlong soft palate Enlarged tonsils Everted laryngeal saccules Hypoplastic trachea Hiatal hernia Stertor / Stridor \+/- laryngeal collapse
Describe narrow nares in BOAS.
Dramatically increase resistance to air flow into the nose
Cartilage supports of the nares tend to collapse during inspiration, requiring even more effort to breathe
Describe laryngeal collapse in BOAS.
Progressive collapse of the larynx
Graded in terms of severity from 1 (least severe) to 3 (most severe)
Rate of progression may be able to be slowed with appropriate treatment
Describe an overlong soft palate in BOAS.
Can partially obstruct air flow into the trachea and cause turbulent airflow in the area of the larynx
What nursing/owner considerations should we have for BOAS patients?
Avoid stress/heat Use harness, not collars Achieve/maintain ideal bodyweight Carefully managed exercise regimes Oxygen therapy Owner education (signs of respiratory distress)
What should we assess pre-operatively in BOAS patients?
TPR
MMs and CRT
SpO2
Clinical signs of BOAS/assessment with vet - ASA grading
What surgical options do we have to treat BOAS?
Soft palate resection (staphylectomy)
Tonsil resection
Removal of everted laryngeal saccules
Nostril resection (correct stenotic nares)
Laster assisted turbinectomy (LATE)
(May be performed together as multilevel surgical correction)
How do we prepare pre-BOAS surgery?
Full discussion with vet (ASA grading)
Informed consent - high risk surgery
Full analysis of biochem/haem
Pre-oxygenate for at least 5 mins - delays O2 desaturation at induction
Minimal stress via handling (IV catheter after premed if needed)
Peri-operatively - ocular lubrication + intensive monitoring
How do we prepare for BOAS surgery?
Ensure all equipment prepared (lighting, laryngoscope, rescue ET tube)
Thoracic radiography
Minimal - no hair clip/scrub
Positioning - sternal, head raised using drip stands
Be ready for regurgitation - tilted table/suction
What monitoring should be carried out peri-operatively?
O2 saturation (>98%)
Capnography - ETCO2 (35-45mmHg)
Use IPPV/mechanical ventilator as appropriate (consider circuit selection)
Blood pressure - mean > 60 mmHg (consider bolus IVFT if indicated)
Ocular lubricant frequently applied
What complications can occur post-BOAS surgery?
Airway swelling
Vomiting and regurgitation
Aspiration pneumonia
How do we recover BOAS patients post-op?
Extubation later than usual
Monitor O2 saturation
O2 supplementation post-extubation (mask/flow-by)
Sternal recumbency, head elevated
Suction available
Intensive monitoring charts - constant supervision
How should BOAS patients post-op be managed at home?
Harness
Restricted exercise 5-10 mins twice daily - 6 weeks
Examination 2 and 10 days post-op
Wet solid food 6 weeks post-op - limit airway irritation
What are the causes of laryngeal paralysis?
Ageing changes (degenerative neuropathy) - idiopathic
Congenital disease
Trauma (bite wounds, neck surgery)
Cancerous infiltration of nerve that controls the muscle
What are the signs of laryngeal paralysis?
Exercise intolerance Noisy respiration Coughing, gagging Change/loss of vocal sounds (dysphonia) Dysphagia Cyanosis and collapse - if severe
How do we manage mild cases of laryngeal paralysis?
Anti-inflammatories Antibiotics - where indicated Sedative Raised feeding Reduce stress and manage exercise
How do we manage severe cases of laryngeal paralysis?
Unilateral arytenoid lateralisation (laryngeal tie-back)
-Diagnosis under light plane of anaesthesia
-Surgery performed on left side of neck
Left arytenoid cartilage permanently tied open
How do we care for laryngeal paralysis patients post-op?
Small, regular soft meals
Avoid dusty food/atmospheres
Raised feeding/water
Wound management
What should we tell owners post-unilateral arytenoid lateralisation surgery?
Discuss permanent change in phonation No swimming (risk of aspiration too great) Prognosis positive unless systemic neuromuscular disorder
What are the two types of palate defects?
Congenital, e.g. clefts of upper lip, hard and/or soft palate (clinical signs = difficulty feeding and nasal discharge)
Acquired, e.g. trauma, RTAs
How do we treat congenital palate defects?
Surgery performed at 3-4 months
Closure of tissues separating the oral and nasal passages with minimal tension
Haemorrhage not uncommon
How do we treat acquired palate defects?
Primary (surgery) or secondary (healing) closure.
What surgical options do we have for tracheal collapse patients?
Extraluminal ring prosthesis
Intraluminal stent
Describe an extraluminal ring prosthesis.
Invasive - risk management
Complications = vascular damage, tracheal ring migration, coughing, dyspnoea, laryngeal paralysis (due to iatrogenic nerve damage)
